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In the general population, particularly in individuals with asthma, cough is a common symptom, often reported after exertion, although regular exercise may be associated with a reduction in the prevalence of cough. In athletes, exercise-induced cough is also a particularly frequent symptom. The main etiologies of cough in athletes are somewhat similar to non-athletes, including asthma/airway hyperresponsiveness, upper airways disorders such as allergic or non-allergic rhinitis, and exercise-induced laryngeal obstruction, although these conditions are more frequently observed in athletes. In these last, this symptom can also be related to the high ventilation and heat exchange experienced during exercise, particularly during exposure to cold/dry air or pollutants. However, gastroesophageal reflux, a common cause of cough in the general population, despite being highly prevalent in athletes, has not been reported as a main cause of cough in athletes. Cough may impair quality of life, sleep and exercise performance in the general population and probably also in athletes, although there are few data on this. The causes of cough should be documented through a systematic evaluation, the treatment adapted according to identified or most probable cough etiology and pattern of presentation, while respecting sports anti-doping regulations. More research is needed on exercise-induced persistent cough in the athlete to determine its pathophysiology, optimal management and consequences., (Copyright © 2019. Published by Elsevier Ltd.)

Background: Cough is a common symptom experienced by athletes, particularly after exercise. We performed a systematic review to assess the following in this population: (1) the main causes of acute and recurrent cough, either exercise-induced or not, (2) how cough is assessed, and (3) how cough is treated in this population. From the systematic review, suggestions for management were developed., Methods: This review was performed according to the CHEST methodological guidelines and Grading of Recommendations Assessment, Development and Evaluation framework until April 2015. To be included, studies had to meet the following criteria: participants had to be athletes and adults and adolescents aged ≥ 12 years and had to complain of cough, regardless of its duration or relationship to exercise. The Expert Cough Panel based their suggestions on the data extracted from the review and final grading by consensus according to a Delphi process., Results: Only 60 reports fulfilled the inclusion criteria, and the results of our analysis revealed only low-quality evidence on the causes of cough and how to assess and treat cough specifically in athletes. Although there was no formal evaluation of causes of cough in the athletic population, the most common causes reported were asthma, exercise-induced bronchoconstriction, respiratory tract infection (RTI), upper airway cough syndrome (UACS) (mostly from rhinitis), and environmental exposures. Cough was also reported to be related to exercise-induced vocal cord dysfunction among a variety of less common causes. Although gastroesophageal reflux disease (GERD) is frequent in athletes, we found no publication on cough and GERD in this population. Assessment of the causes of cough was performed mainly with bronchoprovocation tests and suspected disease-specific investigations. The evidence to guide treatment of cough in the athlete was weak or nonexistent, depending on the cause. As data on cough in athletes were hidden in a set of other data (respiratory symptoms), evidence tables were difficult to produce and were done only for cough treatment in athletes., Conclusions: The causes of cough in the athlete appear to differ slightly from those in the general population. It is often associated with environmental exposures related to the sport training environment and occurs predominantly following intense exercise. Clinical history and specific investigations should allow identification of the cause of cough as well as targeting of the treatment. Until management studies have been performed in the athlete, current guidelines that exist for the general population should be applied for the evaluation and treatment of cough in the athlete, taking into account specific training context and anti-doping regulations., (Copyright © 2016 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.)

Purpose of Review: Asthma and exercise-induced bronchoconstriction (EIB) are common in the athlete and can interfere with sport performances. In this review, we report recent findings on the prevalence, diagnosis and evaluation of these conditions, in addition to specific issues regarding their treatment and antidoping regulations., Recent Findings: Recent studies confirmed the high prevalence of exercise-induced respiratory symptoms, asthma and EIB, in athletes and showed that these conditions are still underdiagnosed and undertreated. Recent studies highlight the suboptimal use of asthma medication in asthmatic and allergic athletes. Regarding the diagnosis and treatment, questions about the role and criteria for positivity of eucapnic voluntary hyperpnea test were raised. It was confirmed that there is a subgroup of athletes with poor response to asthma medication. Finally, regarding antidoping regulations, new methods and changes in criteria for urinary bronchodilator thresholds were suggested., Summary: Recent publications confirm that exercise-induced respiratory symptoms, asthma and EIB are common in athletes but often unrecognized and not optimally or successfully treated. It was suggested that current criteria for diagnostic bronchoprovocation test responses could be reassessed, as well as antidoping criteria for β2-agonists urinary levels. There is a need for more research on prevention of airways dysfunction in athletes, identification of different asthma phenotypes and the benefits of standard asthma medication in this population.

Objectives: This study aimed to evaluate the levels of 8-isoprostane (8-IsoP) in the airways of competitive swimmers at baseline and after a swimming session according to their airway responsiveness., Methods: Twenty-three swimmers and six lifeguards had a baseline spirometry and bronchoprovocative challenges. During a second visit, swimmers performed a usual swimming session while lifeguards stayed in the same pool environment for the same time period. Forced expiratory volume in one second (FEV1) was measured before and 5 min after the end of the session. Exhaled breath condensate (EBC) was sampled before and 10 min after the session and EBC 8-IsoP levels were analysed by enzyme immunoassay. Change in EBC 8-IsoP from baseline to post-swimming session was calculated., Results: We observed no relationships between airway hyper-responsiveness and 8-IsoP values before or after swimming in swimmers. The levels of 8-IsoP were significantly higher after the training session (mean value 2.9, s = 0.5 pg mL(-1)) than at baseline (mean value 1.9, s = 0.4 pg mL(-1)) in swimmers only (p = .012). EBC 8-IsoP levels after the swimming session significantly correlated with the percent change in FEV1 after swimming., Conclusions: EBC 8-IsoP levels were increased after training in swimmers but not in lifeguards, suggesting that exercise-induced hyperpnoea in a chlorinated pool environment increases airways oxidative stress.

Background: Despite the health benefits of swimming as a form of exercise, evidence exists that both the swimming pool environment and endurance exercise are etiologic factors in the development of asthma. The prevalence of asthma in swimmers is high compared with that in participants in other Olympic sport disciplines. There are no publications comparing the prevalence of asthma in the 5 aquatic disciplines., Objective: The purpose of this study is to examine and compare the prevalence of asthma in the aquatic disciplines and in contrast with other Olympic sports., Methods: Therapeutic Use Exemptions containing objective evidence of athlete asthma/airway hyperresponsiveness (AHR) were collected for all aquatic athletes participating in swimming, diving, synchronized swimming, water polo, and open water swimming for major events during the time period from 2004-2009. The prevalence of asthma/AHR in the aquatic disciplines was analyzed for statistical significance (with 95% CIs) and also compared with that in other Olympic sports., Results: Swimming had the highest prevalence of asthma/AHR in comparison with the other aquatic disciplines. The endurance aquatic disciplines have a higher prevalence of asthma/AHR than the aquatic nonendurance disciplines. Asthma/AHR is more common in Oceania, Europe, and North America than in Asia, Africa, and South America. In comparison with other Olympic sports, swimming, synchronized swimming, and open water swimming were among the top 5 sports for asthma/AHR prevalence., Conclusion: Asthma/AHR in the endurance aquatic disciplines is common at the elite level and has a varied geographic distribution. Findings from this study demonstrate the need for development of aquatic discipline-specific prevention, screening, and treatment regimens., (Copyright © 2015 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.)

Aim: To evaluate the changes in airway responsiveness to methacholine inhalation test (MIT) when performed after an eucapnic voluntary hyperpnea challenge (EVH) in athletes., Methods: Two MIT preceded (visit 1) or not (visit 2) by an EVH, were performed in 28 athletes and 24 non-athletes. Twelve athletes and 13 non-athletes had airway hyperresponsiveness (AHR) to methacholine, and 11 athletes and 11 non-athletes had AHR to EVH (EVH+)., Results: The MIT PC20 post-EVH was significantly lower compared to baseline MIT PC20 by 1.3±0.7 doubling-concentrations in EVH+ athletes only (p<0.0001). No significant change was observed in EVH- athletes and EVH+/EVH- non-athletes. A significant correlation between the change in MIT PC20 post-EVH and EVH+/EVH- status and athlete/nonathlete status was found (Adjusted R2=0.26 and p<0.001). Three (11%) athletes and one (4%) non-athlete had a change in the diagnosis of AHR when MIT was performed consecutively to EVH., Conclusion: The responsiveness to methacholine was increased by a previous indirect challenge in EVH+ athletes only. The mechanisms for such increase remain to be determined. MIT and EVH should ideally be performed on separate occasions as there is a small but possible risk to obtain a false-positive response to methacholine when performed immediately after the EVH., Trial Registration: ClinicalTrials.gov NCT00686491.

Background: Cardiorespiratory disorders are common in athletes. However, these conditions are often underdiagnosed, which potentially results in impaired performance and increased health risks. The aim of this study was to evaluate, in a research setting, the prevalence of cardiorespiratory disorders in athletes in order to determine the potential value of a screening program., Methods: One hundred thirty-three athletes were studied. Each subject underwent a physical examination. A eucapnic voluntary hyperventilation (EVH) test and a methacholine inhalation test were performed to confirm the diagnosis of asthma. A cardiovascular evaluation was also performed, including maximal exercise test with electrocardiogram, 24-hour ambulatory blood pressure monitoring, 24-hour Holter monitoring, and blood sampling., Results: Seventy-four (56%) athletes had airway hyperresponsiveness to EVH or the methacholine inhalation test. Among those with airway hyperresponsiveness, 45 (61%) athletes were only hyperresponsive to EVH, and 10 (14%) were only hyperresponsive to the methacholine inhalation test (using the criteria of a PC20 ≤ 4 mg/mL). Thirty-two (24%) athletes had a known diagnosis of asthma, while 34 (26%) athletes received a new asthma diagnosis. Ninety-seven (73%) athletes were sensitized to common airborne allergens. Forty-seven (35%) athletes completed the cardiovascular evaluation. Three (6%) and 7 (15%) athletes had a previous or new diagnosis of cardiovascular disease, respectively. Resting systemic hypertension was documented in 2 (4%) athletes and exaggerated blood pressure response to exercise was found in 12 (26%) athletes., Conclusion: This cardiorespiratory screening data set in athletes showed a high prevalence of exercise-induced asthma and exercise hypertension, which in many cases were not previously diagnosed.

Background: Airway hyperresponsiveness is highly prevalent in competitive swimmers, but it is unknown whether this is transient or persistent., Objectives: To document changes in airway responsiveness and airway inflammation in elite swimmers during intense training and rest., Methods: Nineteen swimmers and 16 healthy controls completed a standardized questionnaire, allergy skin prick tests, exhaled nitric oxide measurement, eucapnic voluntary hyperpnea testing, methacholine challenge, and induced sputum analysis. Testing was performed during intense swimming and after at least 2 weeks of rest., Results: Sixteen swimmers and 13 controls were atopic. Airway responsiveness to methacholine and eucapnic voluntary hyperpnea was significantly higher in swimmers than in controls (P < .0001). A significant decrease in airway responsiveness was observed from training to rest in swimmers only (P < .005). This occurred with both methacholine challenge--with PC(20) values of 6.0 mg/mL and 12.8 mg/mL, respectively--and eucapnic voluntary hyperpnea testing--with a maximum fall in FEV(1) after voluntary testing of 14.1 L and 10.1 L, respectively. Eight of 12 swimmers with airway hyperresponsiveness during intense training had normal airway responsiveness during rest. No airway inflammation occurred, and no significant change in this parameter was observed from training to rest., Conclusion: Training may contribute to the development of airway hyperresponsiveness in elite swimmers, but this seems reversible in many athletes after training cessation for at least 2 weeks., (Copyright © 2010 American Academy of Allergy, Asthma & Immunology. Published by Mosby, Inc. All rights reserved.)

Unlabelled: This study was aimed at the following: (1) the prevalence of airway hyperresponsiveness (AHR) and exercise-induced bronchoconstriction (EIB) in swimmers and winter sport athletes according to the previously recommended regulatory sport agencies criteria, (2) the relationship between respiratory symptoms and AHR/EIB, (3) the impact of the chosen cutoff value for AHR on its prevalence, and (4) the effect on the prevalence of the positive eucapnic voluntary hyperpnea (EVH) test of using the highest vs the lowest spirometric post-EVH values to calculate the magnitude of the airway response. We compared the prevalence of respiratory symptoms with responses to methacholine challenge and EVH in 45 swimmers, 45 winter sport athletes, and 30 controls. Two methacholine challenge cutoffs for AHR were analyzed:

Skiers and swimmers present characteristics of airway inflammation and remodelling of the extracellular matrix similar to what is observed in mild asthma. We aimed to compare serum and sputum MMP-9/TIMP-1 levels, to assess the balance between airway fibrogenesis and inflammation process in both categories of athletes, and to observe its seasonal variations in winter sports athletes. We conducted a retrospective study. Winter sports athletes (n = 41), swimmers (n = 25) and healthy nonathletes (n = 10) had blood sampling, lung function measurement, skin prick tests, eucapnic voluntary hyperpnoea challenge, methacholine inhalation test, and induced sputum analysis. Twelve winter sport athletes performed the tests during both summer and winter. Serum and sputum biomarkers were measured by ELISA. No significant difference in serum or sputum MMP-9/TIMP-1 ratio was observed between groups, nor relationship with airway function or responsiveness. Serum MMP-9/TIMP-1 ratio was higher during the summer in winter sport athletes compared with winter season (median [Interquartile range]: 3.65 [2.47-4.03] ng.ml−1 and 1.27 [0.97-1.62] ng.ml−1, respectively, p = 0.005). Sputum MMP-9 correlated with methacholine PC20 (r = 0.45, p = 0.019) and serum cc16/SP-D ratio (r = −0.47, p = 0.013). MMP-9/TIMP-1 ratio in sputum or serum may fluctuate with training or environment but does not correlate with airway function or responsiveness in athletes. [ABSTRACT FROM AUTHOR]

Aim: To summarise lung function characteristics of athletic swimmers and discuss mechanisms explaining these changes while putting forward the lack of a clear understanding of the precise physiological factors implicated. Methods: Literature search until 07.2021 on Medline and EMBASE using keywords swimming, athletes, respiratory physiology, lung development, lung function tests. Relevant articles in French and English were reviewed. Results: We found insufficient data to perform a meta‐analysis. However, there is evidence that swimmers have better expiratory flows and increased baseline lung volumes than non‐athletes or non‐swimmers. Although these features can result from changes in lung development following intense training over the years, the contribution of a genetic predisposition and positive selection cannot be totally excluded. Conclusion: Disentangling the participation of constitutional factors and years of hard training to explain the larger lung volumes of athletic swimmers is in favour of an adaptative response of the lungs to early swim training through modification of the pathway of lung development. There seems to be an optimal window of opportunity before the end of growth for these adaptational changes to occur. Precise mechanisms, and contribution of adaptative change on lung physiology, remain to be further studied. [ABSTRACT FROM AUTHOR]

Transient airway narrowing can occur during or following exercise, a phenomenon called exercise-induced bronchoconstriction (EIB). The main mechanism of EIB is considered to be airway dehydration, resulting from increased ventilation during exercise. In asthma, such water loss causes an increase in airway fluid osmolarity, inducing airway smooth muscle contraction following the release of mediators from airway inflammatory cells. Asthmatics frequently experience EIB, but it may also be observed in others not reporting asthma symptoms, particularly elite endurance athletes. Individuals with asthma often refrain from performing physical exercise because they fear troublesome respiratory symptoms. However, in addition to its well-known cardiovascular and metabolic benefits, physical training has been shown to be beneficial for asthmatic adults and children in improving asthma control and asthma-related quality of life. Exercise training also reduces the risk of asthma exacerbations, improves exercise capacity, and decreases frequency and severity of EIB. To minimize the risk of EIB, asthma must be well controlled, and specific pharmacological and nonpharmacological preventative measures can be taken. Counterintuitively, in high-level athletes, the development of asthma, airway hyperresponsiveness, and EIB can be promoted by intense training over many years following exposure to environmental conditions, such as cold air, pollutants, and allergens. As for nonathletes, athletes must have optimal asthma control and apply preventative measures against EIB, taking into account antidoping regulations for asthma medications. A better understanding of the impact of exercise on asthma should improve the overall care of asthmatic patients. [ABSTRACT FROM AUTHOR]

Endurance athletes have a high prevalence of airway diseases, some possibly representing adaptive mechanisms to the need of conditioning large volumes of inspired air during high ventilation in specific environments. The aim of this study is to assess the ability to condition (warm and humidify) inspired air in athletes by measuring the difference between inhaled and exhaled air temperature (ΔT) during and after eucapnic voluntary hyperpnea (EVH) test. Methods: Twenty-three endurance athletes from various sports, 12 with airway hyperresponsiveness (AHR) and/or exercise-induced bronchoconstriction (EIB) (A+), 11 without AHR and/or EIB (A-), 12 nonathletes with AHR and/or EIB (C+), and 11 nonathletes without AHR and/or EIB (C-) were recruited. All subjects attended the laboratory on three occasions, twice for baseline characteri-zation, including questionnaires, pulmonary function, methacholine bronchoprovocation, allergy skin prick tests, exhaled nitric oxide measurement, and a standard EVH, and once to perform a modified EVH to assess ΔT. Inspired and expired air temperatures were measured with a high-precision probe during EVH and at regular intervals until 30 min after the end of the test. Results: The global ΔT during the EVH was +5.8°C ± 1.5°C and +4.7°C ± 1.5°C during the 30 min after the EVH. No difference was found between groups for either the AT or the slope of ΔT, during and after the EVH. Conclusion: This study shows no evidence of improved capacity to condition inspired air in endurance athletes, which could have suggested an increased bronchial blood flow or another adaptive mechanism. The absence of an adaptive mechanism could therefore contribute to airway damage observed in athletes in allowing colder but mainly dryer air to penetrate deeper in the lung. [ABSTRACT FROM AUTHOR]

Background: Exercise-induced cough (EIC) is frequently reported by winter athletes, but this symptom is not always associated with exercise-induced bronchoconstriction (EIB). The aims of this study were to determine if EIC can be inhibited or reduced with the inhalation of ipratropium, and if EIC in winter athletes is associated with EIB. Methods: On 2 visits, 24 cross-country skiers (10 males and 12 females, mean age 17 ± 3 years) performed an outdoor exercise in the winter (30-minute warm-up, followed by a 3-minute sprint), randomly preceded by the inhalation of ipratropium or a placebo. A spirometry was done at baseline and 20 minutes after inhalation of ipratropium or placebo. Exercise was then performed, followed by the measurement of forced expiratory volume in 1 second and the recording of the number of coughs until 60 minutes after exercise. Before and after exercise, the perception of cough intensity was evaluated using a modified Borg scale. Results: Twelve of 16 athletes who completed the study (75%) were symptomatic following exercise with placebo (number of coughs $ 5), but none developed EIB. For these athletes, the number of coughs after exercise (mean number of coughs ± standard deviation: placebo, 26 ± 14; ipratropium, 25 ± 23; P value, nonsignificant) and the maximal perception score for cough intensity (mean Borg score ± standard deviation: placebo, 1.9 ± 1.2; ipratropium, 2.0 ± 1.1; P value, nonsignificant) were not significantly different between ipratropium and placebo. A decrease in the number of coughs was observed in 6 of the symptomatic athletes and an increase was observed in the other 6, resulting in a nonsignificant mean effect. Conclusions: Ipratropium does not appear to significantly influence the number and the perception of cough following exercise. Moreover, these results suggest that EIC is not mainly associated with EIB. However, a subgroup of athletes seems to show a beneficial response to ipratropium, suggesting different cough responses in this population. [ABSTRACT FROM AUTHOR]

Elite athletes, particularly those engaged in endurance sports and those exposed chronically to airborne pollutants/irritants or allergens, are at increased risk for upper and lower airway dysfunction. Airway epithelial injury may be caused by dehydration and physical stress applied to the airways during severe exercise hyperpnoea and/or by inhalation of noxious agents. This is thought to initiate an inflammatory cascade/repair process that, ultimately, could lead to airway hyperresponsiveness (AHR) and asthma in susceptible athletes. The authors review the evidence relating to prevention or reduction of the risk of AHR/asthma development. Appropriate measures should be implemented when athletes exercise strenuously in an attempt to attenuate the dehydration stress and reduce the exposure to noxious airborne agents. Environmental interventions are the most important. Non-pharmacological strategies can assist, but currently, pharmacological measures have not been demonstrated to be effective. Whether early prevention of airway injury in elite athletes can prevent or reduce progression to AHR/asthma remains to be established. [ABSTRACT FROM AUTHOR]

Elite competitive swimmers are particularly affected by airway disorders that are probably related to regular and intense training sessions in a chlorinated environment. Upper and lower airway respiratory symptoms, rhinitis, airway hyper-responsiveness, and exercise-induced bronchoconstriction are highly prevalent in these athletes, but their influence on athletic performance is still unclear. The authors reviewed the main upper and lower respiratory ailments observed in competitive swimmers who train in indoor swimming pools, their pathophysiology, clinical significance and possible effects on performance. Issues regarding the screening of these disorders, their management and preventive measures are addressed. [ABSTRACT FROM AUTHOR]

Respiratory diseases such as asthma, chronic cough, recurrent respiratory infections and various upper airways conditions are common in elite athletes, but these conditions are often under diagnosed and undertreated. Recurrent cough, often observed after exercise, is the most commonly reported symptom in athletes, particularly winter athletes, but it does not predict airway function; its intensity correlates with the dryness of inspired air but may not be associated with airway hyper responsiveness. Rhinitis, either allergic or not, is highly prevalent in athletes, particularly non-allergic rhinitis in swimmers. Finally, dysfunctional breathing, including vocal cord dysfunction, may mimic or accompany asthma in a significant number of athletes. These conditions should be recognized and treated properly according to current guidelines, although how these last apply in the athlete is uncertain. Furthermore, regulatory agencies' restrictions on the type of drugs allowed for therapeutic use of these conditions in competitive athletes should be checked. [ABSTRACT FROM AUTHOR]

Regular physical activity is recognized as an effective health promotion measure. Among various activities, swimming is preferred by a large portion of the population. Although swimming is generally beneficial to a person's overall health, recent data suggest that it may also sometimes have detrimental effects on the respiratory system. Chemicals resulting from the interaction between chlorine and organic matter may be irritating to the respiratory tract and induce upper and lower respiratory symptoms, particularly in children, lifeguards and high-level swimmers. The prevalence of atopy, rhinitis, asthma and airway hyper-responsiveness is increased in elite swimmers compared with the general population. This may be related to the airway epithelial damage and increased nasal and lung permeability caused by the exposure to chlorine subproducts in indoor swimming pools, in association with airway inflammatory and remodelling processes. Currently, the recommended management of swimmers' respiratory disorders is similar to that of the general population, apart from the specific rules for the use of medications in elite athletes. Further studies are needed to better understand the mechanisms related to the development or worsening of respiratory disorders in recreational or competitive swimmers, to determine how we can optimize treatment and possibly help prevent the development of asthma. [ABSTRACT FROM AUTHOR]

Summary: Background: Although athletes have a high prevalence of airway hyperresponsiveness (AHR) and asthma, little is known about possible gender differences in regard to these features. We looked at the comparative prevalence of AHR, physician-diagnosed asthma and respiratory symptoms during exercise in female (F) and male (M) athletes. Method: A retrospective analysis was done on 2 groups of athletes: Group 1 (n =100) taking part in a study on the prevalence of AHR to methacholine (PC20 <16mg/ml) and Group 2 (n =698), taking part in a provincial survey on the prevalence of physician-diagnosed asthma. Subjects from both groups filled the same questionnaire on respiratory symptoms during exercise (breathlessness, wheezing and chest tightness). Results: In Group 1, prevalence of AHR was significantly higher in female (60%) compared with male (21.5%, p <0.0001) athletes despite a similar prevalence of physician-diagnosed asthma (F: 17.1%, M: 15.4%, p >0.05). Respiratory symptoms during exercise were more frequently reported in females (37.1%, M: 16.9%, p =0.02); however, when corrected for the PC20, this difference became non-significant. In Group 2, the prevalence of physician-diagnosed asthma was not different between genders (F: 12.5%, M: 14%, p >0.05) but respiratory symptoms during exercise were more often reported in female (19.4%) than in male (12.2%, p =0.01) athletes. Conclusions: This analysis shows a higher prevalence of AHR and exercise-induced respiratory symptoms in female compared to male athletes, but a similar prevalence of physician-diagnosed asthma. This suggested that the increase in respiratory symptoms in female athletes failed to translate into a higher prevalence of physician-diagnosed asthma. [Copyright &y& Elsevier]

The article discusses a study which explores the effect of air quality on the performance of athletes with asthma. The study highlights the vital role of air quality on the performance of athletes especially those who have asthma since air quality affects the capacity of the pulmonary system to meet the demands for ventilation and gas exchange to working skeletal muscles. Athletes participating in outdoor endurance events at sites with poor air quality were assessed to have higher risk of developing extrathoracic respiratory problems and exercise-induced-bronchospasm. The study also found that many athletes with asthma have successfully competed at international events due to good air quality.

Objectives: Chloramines, which are produced by the reaction of chlorine with the organic matter present in indoor pools, are potential airway irritants in swimmers. The objective of this study was to compare the prevalence of health complaints of young swimmers and young indoor soccer players and to evaluate the relationship between chloramine concentrations and the athletes’ health complaints. Methods: Health complaints were first (Part 1) documented by questionnaire in 305 competitive swimmers and 499 indoor soccer players of the Québec City region (Canada). Then, (Part 2) health complaints were documented during five training sessions in 72 competitive swimmers in comparison to 73 soccer players. The chloramines in the swimming pool air and water were measured as well as the peak expiratory flow (PEF) before and after the training session. Results: In Part 1, the swimmers reported more lower (adjusted OR: 1.5; IC95%= 1.0–2.2) and upper respiratory symptoms (adjusted OR: 3.7; IC95%= 2.4–5.8). In Part 2, the swimmers experienced more frequent lower (adjusted OR: 3.5; IC95%= 2.0–6.0) and upper respiratory symptoms (adjusted OR: 3.1; IC95%= 1.8–5.4). Overall, swimmers exposed to the highest levels of chloramines in the air and water had more respiratory complaints. Conclusions: Swimmers exposed to chlorination by-products in both the water and air of indoor swimming pools experience frequent respiratory symptoms that could potentially be reduced by limiting exposure to these products. [ABSTRACT FROM AUTHOR]

Purpose: There is an increased prevalence of asthma and airway hyperresponsiveness in elite athletes, particularly in swimmers. High intensity exercise may induce airway inflammation and subsequent remodelling in these subjects. Our aim was to evaluate the effects of high-intensity training on induced-sputum cell populations in elite athletes. Methods: Swimmers and runners with hyperresponsive airways (SH and RH), defined by a provocative concentration of methacholine inducing a 20% decrease in FEV1 (PC20) <16 mg/ml or with normoresponsive airways (PC20> 16 mg/ml; SN, RN) to methacholine were enrolled. The mean PC20 was 2.27 mg/ml in SH (n=12), 32.2 in SN (n=10), 3.25 in RH (n=10) and 41.5 in RN (n=13). All athletes had two induced sputum analyses at one- to two-week intervals in random order: after a period of 72 hours without training, 24 hours after a training session. Results: PC20 was unchanged after training. The median % neutrophils and eosinophils in groups SH, SN, RH, and RN, respectively, were 26.5-1.6, 8.6- 0.3, 28.0-0.03 and 25.5-0.1 before and 45.0-0.5, 31.1-0.4, 54.0-0.6 and 48.3-0.3 after training. While the magnitude of the increase in neutrophils was similar for all groups, it reached statistical significance (pre-post-training) only in the SH group (P = 0.039). Conclusion: A one-hour session of high-intensity training was associated with an increase in airway neutrophils among hyperresponsive swimmer athletes, while airway responsiveness remained unchanged in all groups. [ABSTRACT FROM AUTHOR]

This study aimed at determining the frequency of respiratory symptoms in high-level athletes and whether respiratory questionnaires are reliable predictors of airway hyperresponsiveness (AHR) in this population compared with control subjects. One hundred high-level athletes exercising in different conditions of ambient air (dry, humid, cold or mixed dry and humid) and 50 sedentary control subjects answered four question sets on exercise-induced symptoms of postnasal drip (Q1), breathlessness, chest tightness and wheezing (Q2), and cough (Q3). Another question set (Q4) evaluated the self-description of nociceptive sensations associated with respiratory symptoms. Methacholine inhalation tests were performed in all subjects to obtain a 20% fall in forced expiratory volume in 1 second (PC[SUB20]). AHR could be detected by questionnaires in 37 of 44 (84%) subjects with a PC[SUB20]&lt:8 mg/mL. Sensitivity to detect AHR varied) between the different subgroups of athletes with each of the question sets; however, no significant differences in sensitivity were observed between the groups of athletes and controls except for Q3 (P=.007), in which athletes exercising in cold air reported more exercise-induced cough. Q2 had a better specificity (83%) than Q3 (77%) and Q4 (64%). Combined question sets revealed that three swimmers, two triathletes, and two controls, who answered negatively to all question sets, had a PC[SUB20]<8 mg/mL. Questionnaires on symptoms and on associated nociceptive sensations may help to detect AHR as well in athletes and controls, although for some subgroups of athletes such as swimmers and triathletes and in some controls, false negative questionnaires can be observed and AHR underreported. [ABSTRACT FROM AUTHOR]